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Surgeon General’s Report – How bad is it anyway?

The United States Surgeon General released a new report on vaping this morning, and it’s already causing uproar all over the internet. Billed as the product of two years’ work, and the first comprehensive federal review on vapor products, it’s targeted solidly on youth vaping. In other words, it’s a huge and expensive exercise in “Think of the children!!!”

Obviously nobody in their right mind is going to advocate that young people start vaping, but the Surgeon General ignores the big question – whether or not this is this actually a problem. Bluntly, all the evidence says it’s not. Sadly the report ignores or distorts this evidence to fit a pre-determined narrative.

The full report is substantial – 298 pages long – so there’s plenty of space for an objective, careful look at the latest research. Instead, Surgeon General Murthy has chosen to air a familiar collection of borderline hysterical “concerns” about the “risks” e-cigarettes pose to America’s young people. If you can steel yourself to actually read it you might find a lot of it sounds like it was cut and pasted from the CDC and Tobacco Free Kids. There’s a reason for that, as we’ll see.

Nobody had much warning that this report was going to be released; just a few hours. That’s unusual for a high-profile public health document, and it raises the suspicion that the SG didn’t want to give anyone a chance to prepare responses to its likely content. If so it hasn’t worked, because responses are already coming thick and fast. Those from the US public health sector are generally supportive; from elsewhere, the criticism has been furious.

Critics Pull No Punches

Fanatical UK anti-tobacco group Action on Smoking and Health announced that they were “puzzled” by the SG’s level of concern about vaping, and pointed out that US smoking rates are going down. That was one of the milder responses. Greek cardiologist Dr Konstantinos Farsalinos, one of the world’s most prolific and respected vaping researchers, pulled fewer punches. Starting by labeling the report’s basic premise – that e-cigarettes are a tobacco product – “as inaccurate as it can get”, he went on to demolish most of its claims. He described the SG’s headline claims about risks of teen vaping “nothing more than emotional statements with no real content in terms of realistic risk.”

Other critics were equally scathing. Clive Bates, a veteran British anti-smoking campaigner who used to run ASH, called it “truly terrible”. Derek Yach, a former WHO executive director who set up the UN’s global tobacco control treaty, said it was “full of false, misleading, deceptive statements” and finished with, “Needs a health warning: do not read.”

It would be easy to dismiss criticism from vapers and the e-cig industry (and the SG’s supporters are busy doing just that) but Derek Yach isn’t a vaper; in fact he’s dedicated most of his adult life to tobacco control. Clive Bates isn’t a vaper either, and he also has a long history of anti-tobacco work. If people like this are outraged at the contents of the report, it’s probably worth wondering why.

How Bad Is It?

Is all this criticism fair? The short answer is yes, it is. The report makes a big deal of the number of teens who reported using an e-cigarette in the last month, but pays almost no attention to whether or not they’re regular vapers or simply experimented once or twice. It’s similarly coy about mentioning the fact teen smoking in the USA is at an all-time low. If e-cigarettes lead to smoking, as the report claims, surely the smoking rate would be going up?

Some other fairly dubious points are hammered home, as well. Youth who vape are also likely to use other tobacco products, the SG says. This is true. It’s also no surprise to anybody. Every study shows that the most common reason for using e-cigarettes is as a replacement for smoking, so we’d expect to find a lot of smokers using e-cigs. There’s also the fact that kids who like to try stuff, try stuff. It’s a safe bet that the kids who vape aren’t just more likely to smoke; they’re more likely to drink beer and have sex, as well.

By this point, the Surgeon General’s report is descending into farce. It trots out the old “ultra-fine particle” argument to suggest that vaping could harm teenagers’ lungs. The source of this ridiculous claim is UCSF professor Stanton Glantz, who has never studied science or medicine, and the research data he based it on was about diesel engine exhaust. The report also mentions heavy metals, but omits the fact that the quantities detected are tiny – a fraction of what’s allowed in an asthma inhaler. There’s a lot of talk about how nicotine can harm brain development – and no mention of the fact that’s only been seen in rats, not humans.

Overall the standard of science is nothing short of abysmal, and even a quick read will find many factual errors. For example, the report describes the Ploom and iQOS – both heat not burn products – as e-cigarettes.

Dangerous Inadequacy

This report wasn’t written to inform the nation about the health risk of e-cigarettes, because there’s no evidence that risk even exists. Its real purpose is probably to justify the FDA’s Deeming Regulations and the host of other anti-vaping laws being brought in all across the country. That shouldn’t be a surprise, because it was almost entirely written by CDC, which under director Tom Frieden has been relentlessly hostile to vaping. One of the reviewers was Matthew Myers of the Campaign for Tobacco-Free Kids, which under his leadership has almost completely given up talking about tobacco and turned into an anti-vaping group.

Vivek Murthy is the least experienced Surgeon General in US history. His appointment in 2013, at the age of 36, came just seven years after he finished his medical residency. At the time many people expressed concerns that he didn’t have the professional experience or maturity needed to be America’s top doctor. In allowing such a biased, misleading and frankly dangerous report to be released by his office, Murthy has proven his critics right.